Sports Rehabilitation Key to Olympic success

1. Sports Rehabilitation Key to Olympic success Bruce Paton Musculoskeletal Extended Scope Physiotherapist – UCLH

2. Outline • Introduction • Case study to show why rehab is important • Principles of rehabilitation • Tissues and healing • Optimally loading tissues and adaptation • Aims of rehabilitation • Specificity of training per olympic sports • UCLH • Musculoskeletal pathways now and in past

3. Introduction • Alistair Brownlee 22 yo triathlete • Winner of ITU WC series 2009 • Feb 2010 – Femoral Stress Fracture • Physiotherapist- Emma Deakin • Return to competition June – madrid • Winner final race ITU WC series • Budapest sat 11 th sept 2010 • Times overall time 01:42:26 • Swim (1500m) 00:17:12 • Bike (40km) 00:53:54 • Run (10km) 00:30:00 • How does and athlete get to this level training ? • What does the athlete do if they get injured ?

4. Rehabilitation principles • Rehabilitation Follows many of the same principles of training • training dealing with strengthening normal tissues ( Nb holds true for athletes & normal population) • Rehabilitation involves strengthening injured tissue

5. After injury – stages of healing Body does a lot of our work !! Thankfully it works to heal itself ! Tissues have capacity for strengthening with training (Adaptation) They adapt to the loads placed on them Science expanding knowledge Tissues and Healing

6. Adaptation progressive overload = tissuestrengthens Increase intensity session Longer recovery required Increase Frequency Reduced rest tissue weakening T I S S U E S T R E N G T H T I M E

7. Different tissues ADAPT and HEAL differently Time scales Recovery times What is OPTIMAL loading for strengthening tissues ? Ie how do you pitch the athlete’s loading correctly Secret to good rehabilitation Correct PACING OF LOADS/TRAINING Frequency Intensity Duration of loading RECOVERY TIME !! Often a difficult factor for olympic athletes make me better Yesterday!! Tissues and Loading

8. Adaptation progressive overload = tissuestrengthens Increase intensity session Longer recovery required Increase Frequency Reduced rest tissue weakening T I S S U E S T R E N G T H T I M E

9. Aims of Rehab – Early • Manage Pain • Manage inflammation • Protection - Brace / tape • Normalise movement • Muscle Control/ Recruitment • Maintain fitness • PSYCHOLOGY

10. Aims of Rehabilitationmiddle stage • Address Biomechanics • Muscle flexibility • Restore joint movement • Muscle Strength • Neurodynamics • Proprioception/ Balance • Cardiovascular fitness • PSYCHOLOGY

11. Aims of Rehabilitationlate stage • M strength Endurance • Speed and power • Impact tolerance / Tissue hardening • Direction change / Pivoting/ Agility • Coordination/ Technique • Control / core stability • Sports Specific work • Return to training / sport • Future jt protection and prevention of re injury • clear all Contributing Factors • PSYCHOLOGY

12. Specificity • Olympic sports • Paralympic sports • Each has very specific demands • Rehab needs to take into account the demands of the sport • TRx and Tq knowledge

13. Aquatics Archery Athletics Badminton Basketball Boxing Canoeing Cycling Equestrian Fencing Football Gymnastics Handball Hockey Judo Modern Pentathlon Rowing Sailing Shooting Table Tennis Taekwondo Tennis Triathlon Volleyball Weightlifting Wrestling Olympic sports

14. Archery Athletics Boccia Cycling Equestrian Football 5-a-side Football 7-a-side Goalball Judo Powerlifting Rowing Sailing Shooting Sitting volleyball Swimming Table tennis Wheelchair basketball Wheelchair fencing Wheelchair rugby Wheelchair tennis Paralympic sports

15. Contributing factors Intrinsic • Skill Technique / movt pattern • Strength / flexibility • Biomechanics Prevention • Long term thinking • Science contribution Extrinsic • Equipment • Surfaces • Footwear • Training schedules • Science

16. NHS experience Rehabilitation Many units lack facilities and expertise to allow High level strengthening Paced return to sport Discharge before full return UCLH Strengths Consultants with sports background Incl SEM consultant Strong multidisciplinary communication Gym based pathway Facilities Expertise Diagnosis / Screening  Prehabilitation  +/- Surgery  Rehabilitation Early stage 1:1 Middle stage 1:1 / Gym  Late stage Gym Return to training Return to sport MSk Rehabilitation pathways at UCLH

17. Rehabilitation at UCLH • Facilities • Dept • Gyms • Hydrotherapy • Systems • Gym based rehab systems • Advanced Gps • 1300 pts since dec05 • Early stage • 700 pts since feb 07 ) • Upper / Lower Limb • Spinal

20. Expertise Long Hx of rehab for high level athletes Physios working with professional sports teams background University teaching links Research studies Inter trust Inservice training Links UCL ISEH Sports MSc Pct BOA / EIS and External sports groups Rehabilitation at UCLH

21. Rehabilitation Opportunities • Opportunities • Systems • Expertise • Volunteering • Further training / teaching • Research strategy • Links • BOA • UCL ISEH and sports MSc • LOCOG

22. Conclusion • Successful rehabilitation • expertise in knowing • demands of sport • Behaviour of healing tissues • Skills in • Optimal pacing of rehabilitation and training • Effective management of contributing factors • Excitement of Games in London • Logistics • Volunteers ( 70,000 reqd / 40,000 paralympics) • Opportunities for UCLH • Strong capabilities • Strong links

23. “To contribute to building a peaceful and better world by educating youth through sport practiced without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play.” International Olympic Committee, ‘Fundamental Principles’, Olympic Charter "To Enable Paralympic Athletes to Achieve Sporting Excellence and Inspire and Excite the World". International paralympic movement - Vision and Mission statement

24. Thank you for listeningQuestions ?